1,721,620 research outputs found
Osteoporosis Epidemiology Using International Cohorts
No full textPurpose of reviewThe field of osteoporosis research has been active for the past 20 years and has allowed significant advancement in the management of osteoporosis. This review will give an overview of the latest data from international cohorts that relate to current and recent osteoporosis research.Recent findingsThe clinical diagnosis of osteoporosis relies heavily on bone mineral density (BMD) measured at femoral neck or spine and although BMD has excellent predictive value for future fractures, fracture risk assessment has evolved over the years, resulting in the birth of fracture prediction tools. Fracture risk factors not currently featured in these tools are being considered for inclusion, including imminent risk fracture following a sentinel fracture, number of falls, and previous vertebral fractures. Data from groups with comorbidities such as chronic obstructive pulmonary disease are helping us understand how to best manage patients with multiple comorbidities. Finally, the prevalence of vertebral fracture in the older general population and other selected populations has been explored, alongside the global burden of osteoporosis and its consequences.SummaryOur understanding of osteoporosis continues to expand, but knowledge gaps remain.</p
Impact of rheumatoid arthritis and its management on falls, fracture and bone mineral density in UK Biobank
No full textObjectives: rheumatoid arthritis (RA) is a systemic chronic inflammatory disease which presents with polyarthritis in addition to extra-articular manifestations. Historically, studies have shown a link between RA and adverse musculoskeletal outcomes but these studies were reported before the widespread use of biologic therapies. The aim of this study was therefore to investigate associations between RA, RA medications and bone mineral density, falls and fractures, using UK Biobank data.
Methods: diagnosis of RA was made using Hospital Episode Statistics (HES) ICD-10 coding. We assessed RA relationships with estimated bone mineral density (eBMD) from heel quantitative ultrasound measurements, self-reported falls (in last year) and HES recorded fracture, adjusted for age, ethnicity, BMI, smoking status and physical activity.
Results: of 502,543 participants, 3849 (1.4%) of women and 1643 (0.7%) of men had a diagnosis of RA. Median age of the participants was 57 years (IQR 50 - 63) in women and 58 (IQR 50 - 64) in men. RA was associated with lower eBMD (men: β -0.244, 95% CI -0.378, -0.110 p<0.001; women: β -0.217, 95% CI -0.297, -0.138 p<0.001) a reported fall in the last year (men: OR 1.54, 95% CI 1.26, 1.87 p<0.001; women: OR 1.36, 95% CI 1.19, 1.56 p<0.001) and fracture in women (OR 1.76, 95% CI 1.43, 2.16 p<0.001). Corticosteroid therapy in men (β -0.934, 95% CI -1.565, -0.304 p=0.004) and disease modifying anti-rheumatic drug (DMARD) use in both sexes (men: β -0.437, 95% CI -0.761, -0.112 p=0.008; women: β -0.243, 95% CI -0.421, -0.065 p=0.007), but not biologic therapy, were associated with a lower eBMD with RA.
Conclusions: RA was associated with lower eBMD, increased falls and fracture. Corticosteroid and DMARD therapy, but not biologic therapy, were associated with lower eBMD
Association between overweight and obesity and risk of clinically diagnosed knee, hip, and hand osteoarthritis: A population-based cohort study
No full textObjective: Previous cohorts have reported associations between overweight/obesity and knee and hand osteoarthritis (OA). However, no data on the effect of these on the OA burden are available. We aimed to analyse the effect of overweight and obesity on the incidence of routinely diagnosed knee, hip, and hand OA.Methods:Design: population-based cohortSetting: primary care records from the SIDIAP database (>5.5 million subjects) covering >80% of the population of Catalonia, Spain.Participants: ?40 years old with no OA on 01/01/2006 and with body mass index (BMI) data available. Follow-up: from 01/01/2006 to 12/31/2010, loss to follow-up, or death.Measures: BMI World Health Organization categories (exposure), and incident clinical diagnoses of knee, hip, or hand OA (ICD-10 codes).Results: 1,764,061 subjects were observed for a median (inter-quartile range) of 4.45 (4.19 to 4.98) years. Incidence rates (per 1000 PY) of knee, hip and hand OA ranged from 3.7 (3.6 to 3.8), 1.7 (1.7 to 1.8) and 2.6 (2.5 to 2.7) amongst normal-weight, to 19.5 (19.1 to 19.9), 3.8 (3.7 to 4.0) and 4.0 (3.9 to 4.2) in the grade II obese respectively.Compared to normal-weight subjects, being overweight or obese increased the risk of OA at all three sites, especially at the knee: overweight and (grade I, II) obesity increased knee OA risk by a factor of 2, 3.1 and 4.7 fold respectively.Conclusions: Both overweight and obesity increase the risk of hand, hip, and knee OA, especially for the latter, with a dose-response gradient with increasing BMI
Prevalence and mortality of individuals with X-linked hypophosphataemia: a United Kindgom real world data analysis
No full textBackgroundX-linked hypophosphatemia (XLH) is a rare multisystemic disease with a prominent musculoskeletal phenotype. We aimed here to improve understanding of the prevalence of XLH across the life course and of overall survival.MethodsThis was a population-based cohort study using a large primary care database in the United Kingdom (UK) from 1995 to 2016. XLH cases were matched by age, gender and practice to up to four controls. Trends in prevalence over the study period were estimated (stratified by age) and survival among cases was compared to controls.FindingsFrom 522 potential cases, 122 (23.4%) were scored as at least possible XLH while 62 (11.9%) were classified as highly likely or likely (conservative definition). In main analyses, prevalence (95% CI) increased from 3.1 (1.5 – 6.7) per million in 1995 – 1999 to 14.0 (10.8 – 18.1) per million in 2012 – 2016. Corresponding estimates using the conservative definition were 3.0 (1.4 – 6.5) to 8.1 (5.8 – 11.4). Nine (7.4%) of the possible cases died during follow-up, at median age 64 years. Fourteen (2.9%) of the controls died. at median age 72.5 years. Mortality was significantly increased in those with possible XLH compared to controls (hazard ratio [HR] 2.93, 95% CI 1.24 – 6.91). Likewise, among those with likely or highly likely XLH (HR 6.65, 1.44 – 30.72).ConclusionsWe provide conservative estimates of the prevalence of XLH in children and adults within the UK. There was an unexpected increase in mortality in later life which may have implications for other FGF23-related disorders
Higher prevalence of non-skeletal comorbidity related to X-linked hypophosphataemia: a UK CPRD parallel cohort study
No full textObjectivesX-Linked hypophosphataemic rickets (XLH) is a rare multisystemic disease of mineral homeostasis that has a prominent skeletal phenotype. The aim of this study was to describe additional comorbidities in XLH patients compared with general population controls.MethodsThe Clinical Practice Research Datalink (CPRD) GOLD was used to identify a cohort of XLH patients (1995–2016), along with a non-XLH cohort matched (1:4) on age, sex and GP practice. Using the CALIBER portal, phenotyping algorithms were used to identify the first diagnosis (and associated age) of 273 comorbid conditions during patient follow-up. Fifteen major disease categories were used and the proportion of patients having ≥1 diagnosis was compared between cohorts for each category and condition. Main analyses were repeated according to Index of Multiple Deprivation (IMD).ResultsThere were 64 and 256 patients in the XLH and non-XLH cohorts, respectively. There was increased prevalence of endocrine (OR 3.46 [95% CI: 1.44–8.31]) and neurological (OR 3.01 [95% CI: 1.41–6.44] disorders among XLH patients. Across all specific comorbidities, four were at least twice as likely to be present in XLH cases, but only depression met the Bonferroni threshold: OR 2.95 [95%CI: 1.47–5.92]. Distribution of IMD among XLH cases indicated greater deprivation than the general population.ConclusionWe describe a higher risk of mental illness in XLH patients compared with matched controls, and greater than expected deprivation. These findings may have implications for clinical practice guidelines and decisions around health and social care provision for these patients
Anti-Osteoporosis medication prescriptions and incidence of subsequent fracture among primary hip fracture patients in England and Wales: an interrupted time-series analysis
No full textIn January 2005, the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance on the use of antiosteoporosis therapies for the secondary prevention of osteoporotic fractures. This was shortly followed in the same year by market authorization of a generic form of alendronic acid within the UK. We here set out to estimate the actual practice impact of these events among hip fracture patients in terms of antiosteoporosis medication prescribing and subsequent fracture incidence using primary care data (Clinical Practice Research Datalink) from 1999 to 2013. Changes in level and trend of prescribing and subsequent fracture following publication of NICE guidance and availability of generic alendronic acid were estimated using an interrupted time series analysis. Both events were considered in combination within a 1-year “intervention period.” We identified 10,873 primary hip fracture patients between April 1999 and Sept 2012. Taking into account prior trend, the intervention period was associated with an immediate absolute increase of 14.9% (95% CI, 10.9 to 18.9) for incident antiosteoporosis prescriptions and a significant and clinically important reduction in subsequent major and subsequent hip fracture: –0.19% (95% CI, –0.28 to –0.09) and –0.17% (95% CI, –0.26 to –0.09) per 6 months, respectively. This equated to an approximate 14% (major) and 22% (hip) reduction at 3 years postintervention relative to expected values based solely on preintervention level and trend. We conclude that among hip fracture patients, publication of NICE guidance and availability of generic alendronic acid was temporally associated with increased prescribing and a significant decline in subsequent fracture
Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics
No full textOBJECTIVES: To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England.DESIGN: Retrospective cohort study.SETTING: English hospital episode statistics database linked to mortality records from the Office for National Statistics.POPULATION: All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation.MAIN OUTCOME MEASURES: All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts.RESULTS: 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22?311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24?303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex.CONCLUSIONS: Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in the long term compared with those undergoing cemented or uncemented total hip replacement. This difference persisted after extensive adjustment for confounding factors available in our data. The study results can be applied to matched populations, which exclude patients who are very old and have had complex total hip replacements. Although residual confounding is possible, the observed effect size is large. These findings require validation in external cohorts and randomised clinical trials
Elevated blood pressure, antihypertensive medications and bone health in the population: revisiting old hypotheses and exploring future research directions
Full text linkBlood pressure and bone metabolism appear to share commonalities in their physiologic regulation. Specific antihypertensive drug classes may also influence bone mineral density. However, current evidence from existing observational studies and randomised trials is insufficient to establish causal associations for blood pressure and use of blood pressure–lowering drugs with bone health outcomes, particularly with the risks of osteoporosis and fractures. The availability and access to relevant large-scale biomedical data sources as well as developments in study designs and analytical approaches provide opportunities to examine the nature of the association between blood pressure and bone health more reliably and in greater detail than has ever been possible. It is unlikely that a single source of data or study design can provide a definitive answer. However, with appropriate considerations of the strengths and limitations of the different data sources and analytical techniques, we should be able to advance our understanding of the role of raised blood pressure and its drug treatment on the risks of low bone mineral density and fractures. As elevated blood pressure is highly prevalent and blood pressure–lowering drugs are widely prescribed, even small effects of these exposures on bone health outcomes could be important at a population level
The effect of rheumatoid arthritis on patient reported outcomes following knee and hip replacement: evidence from routinely collected data
Full text linkObjectivesTo compare outcomes of total knee replacement (TKR) and total hip replacement (THR) for individuals with RA and OA.MethodsWe performed a cohort study using routinely collected data. Oxford Knee Score, Oxford Hip Score, and EuroQol 5-dimension 3-level (EQ-5D-3L) questionnaires were collected before and 6 months after surgery. Multivariable regressions were used to estimate the association between diagnosis and post-operative scores after controlling for pre-operative scores and patient characteristics.ResultsStudy cohorts included 2070 OA and 142 RA patients for TKR and 2030 OA and 98 RA patients for THR. Following TKR, the median Oxford Knee Score was 37 [interquartile range (IQR) 29–43] for OA and 36 (27–42) for RA while the median EQ-5D-3L was 0.76 (0.69–1.00) and 0.69 (0.52–0.85), respectively. After THR, the Oxford Hip Score was 42 (IQR 36–46) for OA and 39 (30–44) for RA while the EQ-5D-3L was 0.85 (0.69–1.00) and 0.69 (0.52–1.00), respectively. The estimated effect of RA, relative to OA, on post-operative scores was −0.05 (95% CI −1.57, 1.48) for the Oxford Knee Score, −0.09 (−0.13, −0.06) for the EQ-5D-3L following TKR, −1.35 (−2.93, −0.22) for the Oxford Hip Score, and −0.08 (−0.12, −0.03) for the EQ-5D-3L following THR.ConclusionTKR and THR led to substantial improvements in joint-specific scores and overall quality of life. While diagnosis had no clinically meaningful effect on joint-specific outcomes, improvements in general quality of life were somewhat less for those with RA, which is likely due to the systemic and multijoint nature of rheumatoid disease
Encounters for foot and ankle pain in UK primary care: a population-based cohort study of CPRD data
Full text linkBACKGROUND: Older patients who have foot pain report variation in access to services to manage their foot health. To plan services it is essential to understand the scale and burden of foot pain that exists for GPs. AIM: To provide UK-wide population-level data of the frequency of foot and/or ankle pain encounters recorded in general practice. DESIGN AND SETTING: Population-based cohort design study using data drawn from the UK Clinical Practice Research Datalink (CPRD) from January 2010 to December 2013. METHOD: All CPRD data were collected prospectively by participating GPs. The primary outcome was prevalence of GP encounters for foot and/or ankle pain, stratified by age, sex, and different subgroups of causes. RESULTS: A foot and/or ankle pain encounter was recorded for 346 067 patients, and there was a total of 567 095 recorded encounters (mean per person 1.6, standard deviation [SD] 1.3). The prevalence of recorded encounters of foot and/or ankle pain was 2980 per 100 000 (3%). The number of patients with a recorded encounter of foot and/or ankle pain was 1820 per 100 000 (1.8%). Foot and/or ankle pain encounters were reported across all age groups (54.4% females), with those aged 71-80 years placing the greatest burden on GPs. The most common specified referrals were to orthopaedics (n = 36 881) and physiotherapy (n = 33 987), followed by podiatry (n = 25 980). CONCLUSION: The burden of foot and/or ankle pain encounters recorded by GPs is not insubstantial, and spans all ages, with a high proportion of referrals to orthopaedics. The authors recommend further exploration of 'first-contact practitioners' for foot and/or ankle pain in general practice to alleviate the burden on GPs.</p
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